PB2260: FIVE-YEAR SINGLE-CENTER EXPERIENCE IN THE TREATMENT OF ADVANCED STAGE CLASSICAL HODGKIN LYMPHOMA WITH ABVD
Authors: Vojin Vukovic, Teodora Karan-Đurašević, Pavle Tulic, Darko Antic, Vladimir Otasevic, Sofija Sarac, Andrej Pesic, Biljana Mihaljevic
Journal: HemaSphere (2023)

Topic: 17. Hodgkin lymphoma - Clinical Background: Advanced stage (AS) classical Hodgkin lymphoma (cHL) carries significant risk of refractoriness to the traditional therapeutic options. Aims: To describe 5-year experience (2016-2020) of Clinic for Hematology, University Clinical Center of Serbia in the treatment of AS cHL with ABVD. Methods: We retrospectively analyzed medical records of 49 patients (pts) who fulfilled criteria for diagnosis of AS cHL according to GHSG. Clinical parameters at diagnosis were collected and correlated with outcome. Results: Median (m) follow up was 47 months (range [r]: 1-79). Median age at diagnosis was 34 years (r: 18-74) with male to female ratio 1.6:1. The most frequent subtype was nodular sclerosis- 73.8%. According to EORTC/LYSA 7 (14.3%) pts were intermediate stage, the rest of 42 (85.7%) pts were AS. Seven (14.3%) pts were Ann Arbor stage II, 26 (53%) pts III, and 16 (32.7%) pts IV. B symptoms were present in 38 (77.6%) pts, and bulky disease ≥7cm in 58% of pts (mostly mediastinal). 34.8% of pts presented with extranodal disease (EN). Low IPS was calculated in 19/35 pts (54.3%), and high IPS in 16/35 pts (45.7%). All pts were treated with ABVD in the first line. Among 12 pts who underwent interim PET/CT, 3 pts were escalated to BEACOPPesc, while 3 pts deescalated to AVD. Median number of cycles administered was 6 (range 3-8). 10/45 pts (22%) received adjuvant radiotherapy (RT). Overall response rate was 72.3% (CR 61.7% + PR 10.6%), while the rest 27.7% of pts were refractory. There was no significant difference in treatment response regarding age (<50y vs ≥50y), Stage, presence of B symptoms, EN, risk by IPS, and adjuvant RT. Median progression-free (PFS) and overall survival (OS) were not reached (NR), while 4-year PFS and OS were 61%, and 89%, respectively. Pts with erythrocyte sedimentation rate (ESR) >50mm/h experienced significantly shorter PFS after first therapeutic line (mPFS 19 months vs. NR; p=0.039, Log-Rank test). Sex, age, stage, B symptoms, END, IPS and adjuvant RT did not make significant difference in PFS in our cohort. Primary refractory patients lived significantly shorter than those who achieved CR/PR after first treatment line (mOS 54 months vs. NR; p=0.004, Log-Rank test). Also, pts had significantly shorter OS if presented with bulky disease (≥7 cm) (p=0.044, Log-Rank test). There was no significant difference in OS regarding sex, age, stage, B symptoms, END, IPS, and adjuvant RT after first treatment line. Among 18 relapsed (13)/refractory (5) (R/R) pts, 17 were treated with high dose chemotherapy (HDC) ± autologous stem cell transplantation (ASCT). Patients who received ASCT after HDC experienced significantly better response (p=0.05, Fisher exact test), and longer PFS (mPFS 14 months vs. 2 months, p=0.02, Long-Rank test) than those without ASCT, however, without significant difference in OS. Fourteen R/R pts were treated with Brentuximab vedotin (BV), 3 pts in consolidation after ASCT (all in CR after BV), and the other 11 pts after median of 3 previous treatment lines (range 2-4) (only 1 patient in CR, one still on BV, and the other 9 pts refractory). Summary/Conclusion: Patients in our cohort experienced shorter PFS if presented with higher ESR, while bulky mass and primary R/R disease were predictors of shorter OS. Patients with R/R cHL had significantly better prognosis if underwent consolidation with ASCT. BV monotherapy was not benefitial in pretreated pts. A significant proportion of AS cHL pts can not be cured with ABVD and require more intensive and/or novel first line treatment options. Keywords: relapsed/refractory, Hodgkin’s lymphoma